Meeting of the Parliament

Meeting date: Wednesday, January 18, 2023

Official Report 1103KB pdf

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National Health Service and Social Care

The next item of business is a debate on motion S6M-07538, in the name of Jackie Baillie, on addressing the crisis in the national health service and social care. I invite members who wish to participate in the debate to press their request-to-speak button now or as soon as possible. We are pretty tight for time, so I urge members to stick to their allocated speaking time and accommodate interventions within that allocation.

14:51  

In opening the debate on the future of the NHS and social care in Scotland, I also want to talk about how we deal with the current crisis. However, I cannot help but note that it is only in Opposition time that we debate the NHS crisis. In Government, the Scottish National Party runs away from accountability.

Every day, lives are being put at risk due to the state of our health service; every day, staff are being asked to perform miracles under increasingly difficult conditions; and, every day, the situation further deteriorates.

At Christmas, the number of Scots who waited more than 12 hours at accident and emergency departments soared to its highest point on record—leaving almost 2,000 people a week stranded in waiting rooms for more than half a day. One in seven Scots is stuck on a waiting list, crucial cancer treatment targets are being badly missed and performance keeps falling to new lows. Delayed discharge has spiralled out of control, which has resulted in more than 1,900 beds being occupied every day by someone who is ready to be discharged but who is waiting for a care package that simply does not exist. The list of failures goes on and on.

Heroic NHS staff are exhausted and demoralised. It is right to thank them, but they do not simply want praise—they want action. The situation is so serious that Dr Iain Kennedy, the chair of the British Medical Association Scotland, has warned:

“There is no way that the NHS in Scotland can survive. In fact, many of my members are telling me that the NHS in Scotland has died already.”

That is a shocking observation from people who are on the front line. Our NHS has served the people of Scotland for decades, so the fact that the very existence of the NHS is now in danger is beyond belief.

For the past 15 years, the NHS in Scotland has been run by the SNP; it is entirely devolved. Cabinet secretary—that is on your watch. In the 600 days that you have been in office, you have performed worse than your predecessors, and things have got worse, not better. It is time that you took some responsibility for those serious failings.

Please speak through the chair, Ms Baillie.

Does Jackie Baillie accept that she is exaggerating somewhat? Some parts of the NHS are clearly struggling, but other parts are doing very well.

I thank John Mason for his intervention, but he might like to note that I quoted the words of Dr Iain Kennedy, the chair of BMA Scotland. He is not exaggerating.

The SNP Government lacks the vision or political will to save our NHS. Last week, Anas Sarwar and I hosted an emergency round-table session to listen to front-line NHS staff. We heard directly from them about the impact that the crisis is having. They told us that it is causing them “moral injury”, because they feel unsupported in their work. One front-line worker said that the conditions in which they were working meant

“no dignity, no respect, no safety for patients.”

They told us that this crisis in our NHS is not because of Covid, flu, Strep A or winter pressures; it is the result of 15 years of SNP failure.

Staff on the front line know best how to restore our NHS, how to save lives and how to modernise the system for the future, but the SNP Government is not interested in listening. The Government’s amendment to our motion says it all—excuse after excuse; it is not our fault—and provides no solutions. What a pitiful dereliction of duty.

Will Jackie Baillie listen to the head of the BMA’s general practitioners committee in Scotland? Dr Andrew Buist said that he

“was not at all convinced by”

Keir Starmer. Dr Buist went on to say:

“His ideas behind reforms seem very marginal and following on from Wes Streeting’s naive comments of GP reform I think further work is required by Labour.”

Is that not a demonstration that, on any subject but particularly health, Labour is completely out of ideas? Will Jackie Baillie tell us who is wrong—the BMA or Scottish Labour?

This is fascinating. This is the cabinet secretary who is presiding over the collapse of the NHS in Scotland, yet he wants to talk about the NHS in England. That is completely irresponsible and a complete dereliction of duty. [Interruption.]

Ms Baillie, will you resume your seat for a second?

We are barely five minutes into the debate and we are already having accusations levelled through the use of “you” and not through the chair, and we have members on the front benches and back benches yelling at one another while somebody is on their feet speaking. I ask for a degree more decorum and respect in the debate, as emotions will be running high, and I ask that we conduct the debate in a respectful manner.

Ms Baillie, I will give you that time back.

Thank you, Presiding Officer.

The SNP turns its back on Scotland’s front-line medics and nurses, while we are listening to their concerns and their ideas for rebuilding the NHS. They tell us that the crisis in the NHS cannot be resolved until we tackle the crisis in primary care and social care. Dr Andrew Buist said:

“Our primary care system is the foundation of the NHS in Scotland and desperately needs more, not less, investment. I genuinely fear for practices already struggling to keep pace with spiralling demand. The consequences for the communities deprived of their GP services—or having to cope with a brutally diminished service—are severe.”

What was the SNP’s response? It cut £5 million from GP budgets and £65 million from primary care. It presided over a cut in the number of whole-time equivalent GPs—numbers have gone down by 81 since 2017—at the same time as it promised more. That is a legacy of failure that is now driving up pressure and demand in the NHS.

However, that is not the only broken promise that is piling pressure on the NHS. Eight years ago, the SNP pledged to end the dangerous and costly practice of delayed discharge. It failed. Tackling delayed discharge is vital in supporting our NHS. As Dr Iain Kennedy has said:

“The key to unlocking the front door of our hospitals lies at the back door.”

He went on to say that the exit block

“is the real reason for many of the issues at the front door of our hospitals.”

The SNP failure to tackle delayed discharge is causing huge capacity issues for hospitals, with potentially deadly results. It is not the fault of the people occupying the beds; it is a failure in social care, due to a lack of investment over years. Until there is parity of esteem between health and social care, we will not end the problem. We must support a system that values health and social care equally, is rooted in the community and is about funding prevention and not just crisis. That means support for voluntary sector activities that sustain people in their communities. The Government’s approach of cutting budgets for such things is short-sighted and just plain wrong.

I turn to social care staff. In the chamber, we have all rehearsed the health vacancies numbers and the exodus of staff from the NHS: there are 6,400 nurse vacancies; there is a 14 per cent vacancy rate for consultants in some areas; and there are too few GPs to cope with demand. However, there is little said about the rising number of social care vacancies and the difficulty in recruiting and retaining staff. Of course, the Government does not bother to gather that data. If social care mattered, the staff would be counted. If social care mattered, the Government would pay the predominantly female staff a decent wage.

Time and time again, Labour has called for decent pay for Scotland’s care workers. In two successive budgets, we have called for a wage of £15 an hour. The Government should start immediately by providing £12 an hour and then negotiate a path to the rest.

However, time and time again, this SNP Government has voted with the Tories against Labour’s proposal. The Greens, who made promises about that in their manifesto, have quietly dropped their promise—the price of their ministerial Mondeos is being paid for by social care staff.

Although the SNP and Greens pay lip service to our care workers, they are happy for them to be paid less than supermarket staff. It is little wonder that we now face an exodus of staff.

Earlier today, I welcomed the social care sector, care workers and family carers to the Parliament for a round-table discussion. They could not have been clearer about the change that is needed.

We must not forget the enormous debt that we owe to family carers, who work day in, day out to care for their loved ones. By doing so, they relieve pressure on the NHS and the social care system.

However, they are being failed, too. Care packages have been slashed and respite care has been withdrawn. The SNP has failed to implement key recommendations of the Feeley review, including scrapping non-residential care charges. That alone would make such a difference to the cost of living for those who rely on social care, but the SNP dithers and delays.

There is no doubt that our NHS and social care system is in disarray. Lives are being lost and staff are exhausted. It does not get any more serious than this. No amount of shuffling the deck chairs will end the crisis.

However, the SNP could act now. Let us have a credible recovery plan that is not just about applying short-term sticking plasters but about applying a long-term approach that recognises the immense contribution of primary and social care.

To start, the Government needs to invest in primary care, reverse the planned cuts and put in place a credible workforce plan that will deliver more GPs and more staff.

In social care, the Government needs to scrap non-residential care charges—that could be done overnight—end delayed discharge and give social care workers a decent wage rise.

The SNP’s flagship national care service is in a great deal of trouble. There is a lack of vision, and it is more about structures than about changing culture. It will cost £1.3 billion, not a penny of which will go on providing direct care. The proposal is increasingly being rejected by stakeholders. Let us pause the National Care Service (Scotland) Bill, use the money to fund care packages now and take the time to get it right.

The NHS and social care are standing at the cliff edge of a catastrophe. The situation could not be graver. I do not believe that all hope is lost. Nye Bevan, the founder of the NHS, said that the system would continue to exist

“As long as there are folk left with the faith to fight for it.”

Scottish Labour is ready to fight for it; NHS staff are ready to fight for it; millions of Scots who owe the NHS their lives are ready to fight for it; and Scotland is ready to fight for it. Is this Government ready to fight for it?

If it is, the Government will back Labour’s motion today. That will send a message to thousands of NHS staff that all is not lost. It will send a message that this Parliament is united, across party lines, in defence of our NHS. It will also send a message to thousands of Scots on waiting lists not to give up hope.

I move,

That the Parliament is deeply concerned about the experiences of patients and staff across Scotland’s NHS; notes that in recent weeks A&E has recorded the worst ever performance against the 4-hour target, levels of delayed discharge have reached their highest ever and record numbers of people are waiting for appointments, tests and treatment; considers that this has not been caused by short-term problems, but is the result of 15 years of the Scottish Government failing to tackle systemic issues in Scotland’s health and social care system, and believes that, instead of sticking plaster solutions, Scotland needs an NHS Recovery Plan that is community care-led, focuses on preventative healthcare, properly values social care and delivers £15 per hour for social care staff, and has a fully-funded and sustainable workforce plan for health and care services so that Scotland’s NHS is fit for the 21st century.

15:03  

I welcome the chance to respond to the motion on the pressures that the NHS and social care are facing. I remind Jackie Baillie and Scottish Labour that the first item of Government business in 2023 was my standing in this very chamber to give an update on those NHS pressures.

I do not wish to be pedantic about it, but I believe that it was a statement that the Opposition had demanded that the cabinet secretary make.

It was not. This Government proactively offered that.

As I have outlined in recent weeks and months, including to the Parliament in that statement last week, this is by any objective measure the most challenging period that Scotland’s NHS has ever faced—and, I suspect, that NHS systems across the United Kingdom have ever faced. We recognise those unprecedented pressures and we put forward a series of actions, which were announced last October, to help our NHS and social care through this very challenging winter.

As I said, Scotland is not alone. Those challenges are being faced not just across the United Kingdom, but in health services around the world. We have encountered the perfect storm of pressures and it is impacting on our health and social care systems.

One of those impacts is noticeably lacking in the motion. There is not a single mention in the Labour motion of Covid-19, which is still exerting enormous pressure on our health service. Not for the first time in the current parliamentary session, Scottish Labour has brought to the chamber a debate about pressures in the health service and has failed to mention the word “pandemic”. To ignore the pandemic and its impacts is to ignore reality.

Will the cabinet secretary take an intervention?

I will shortly.

I am all for debate on our NHS, but the debate must be grounded in reality. Our entire health and social care system is still facing the continued impact of the pandemic, which is the biggest challenge that our NHS has faced in its 74-year existence. Indeed, the most recent statistics show that Covid is at its highest level since the summer. In the week ending 15 January, there were 1,100 patients in hospital with Covid-19. That represents a doubling of the number of patients since November.

The motion euphemistically refers to the global pandemic that has caused such loss and suffering around the world as a “short-term” problem. Covid is not and never will be a short-term problem. I say to members that they should try telling those who have lost a loved one to Covid this week or over the course of the past three years that Covid is a short-term problem, or telling those who are suffering from long Covid that the pandemic is a short-term problem. To describe Covid as a short-term problem is an insult to every person who has suffered or continues to suffer so badly as a result of this dreadful virus. If Labour had any decency, they would apologise for putting such an insensitive motion in front of Parliament today.

The cabinet secretary will be unsurprised by what I am about to say, because we have done this dance before. Of course there has been a global pandemic, and nobody can deny the impact that that has had on our health service. However, the problems were manifest in our health service and in social care well before anybody had heard of Wuhan, China. The retired chief executive of NHS Scotland, Paul Gray, said that the pandemic only hastened the date of the crisis, which was always coming down the track.

As I said, members cannot airbrush the impacts that the pandemic has had on our NHS.

I pay tribute to the extraordinary efforts of our workforce across the entire NHS and social care systems. Our deep appreciation of our workforce is reflected in our commitment to having constructive industrial relations with the unions that represent the workers in our services. I am pleased to say that, due to that approach and the meaningful dialogue and positive engagement that I and the Government have had with our trade unions, Scotland is the only part of the UK that is not experiencing strike action by health staff this winter.

In Conservative-controlled England and Labour-controlled Wales, the respective Governments have singularly failed to engage meaningfully with their workforces. As a result, we see nurses taking strike action—regretfully, I do not doubt—today and tomorrow.

What would the cabinet secretary say to the senior clinician who said to me last week,

“I am thinking of chucking it, to be honest. I actually do not know anyone who isn’t starting to think of chucking it. The NHS is finished.”

Does the cabinet secretary agree with his back benchers that such people are exaggerating?

I speak to clinicians every day of the week; in fact, I spoke to the Royal College of Emergency Medicine today. What I would say to the individual who spoke to Michael Marra is that we will reward them appropriately. That is why we are making the single biggest pay offer—a record pay offer, and one that has not been made in Wales or in England. We are going to make sure that they are rewarded and we will continue to invest in our workforce.

What have we done about some of the incredible pressures that our NHS is facing? The Scottish Government’s draft budget includes additional investment to increase the adult social care wage, and the creation of the national care service will provide a real opportunity for underpinning fair work in social care and delivering national sectoral bargaining for social care workers. However, no one should be in doubt about that: we are not waiting for the national care service to come to fruition to make those improvements in social care.

To address some of the demands in the system that we currently face—

Will the cabinet secretary take an intervention?

If the member does not mind, I want to make some progress. I have taken a few interventions.

I have announced £8 million to procure an additional 300 interim care home beds on top of the 600 that we are already using. I have also announced further plans to recruit additional staff for NHS 24, which is an incredible service, to help us to reduce some of the demand at the front door of acute services.

As health secretary, I retain the emergency powers and the ability to direct that are set out in the National Health Service (Scotland) Act 1978. I am well aware that a number of members have called for a national major incident to be declared or for the NHS to be put back on to an emergency footing. However, a blanket pause of elective procedures would be the wrong thing to have as there would be significant impacts on the health service and, crucially, on patients who are waiting. It is important that we allow NHS boards to make the necessary decisions at local level. Of course, I have provided guidance and will give support to NHS boards where possible.

Our strategy is unapologetic. We will invest in social care to try to help with the exit block, which we know is causing significant challenges at our busiest acute sites, and we will do our best to reduce demand at the front door. Our work on that is beginning to pay off. We see that attendance at the front doors of busy hospitals is lower than the pre-pandemic level. People are coming in sicker and with higher acuity—that comes across from clinicians on the front line day in and day out—but, if we deal with the front door and the exit block, we can make a difference and see that recovery. We have a relentless focus on that.

It is good to hear about the work that is intended to improve the situation, but the cabinet secretary knows as well as I do that, in Lanarkshire, we have had a code black situation for quite a long time now—hundreds of days—and we are not seeing that improvement. We talk about wellbeing and safety for patients and staff, but it is not fair work if people have to go to their work every day and work at the highest possible level of risk in the NHS. When will we see improvements in Lanarkshire? Is there any chance that we will de-escalate from code black any time soon?

Please begin to conclude, cabinet secretary.

I absolutely think that we will see an improvement in Lanarkshire. I have spoken to the new chief executive, Jann Gardner, and I urge Monica Lennon to do so if she has not had the opportunity. I have been very impressed by the ideas that Jann Gardner has brought forward to try to make improvements in Lanarkshire. It is well worth Monica Lennon’s time to speak to the new chief executive.

I have no doubt that we still have challenging times ahead in our NHS, but I remain confident that, with the combined efforts of an incredible workforce and the will of the Government, as outlined in the amendment in my name, those challenges will be met and overcome.

I end where I started, by paying tribute to our brilliant NHS and social care staff, who provide exceptional care during the most challenging times. I offer them a promise that we will honour them not just by our warm words, but by our deeds.

I move amendment S6M-07538.2, to leave out from “is deeply” to end and insert:

“recognises the unprecedented pressure that NHS and care staff have faced over the winter and thanks them for all their efforts in caring for the people of Scotland at this challenging time; notes that these are challenges that are being faced across the UK and beyond; recognises that the triple impact of Brexit, the COVID-19 pandemic and the UK Government’s cost of living crisis has exacerbated the pressures faced by the health service; believes that freedom of movement within Europe would be beneficial to help addressing recruitment challenges, and that the only route to securing that is membership of the European Union; welcomes that constructive industrial relations in Scotland’s health service mean that Scotland is the only part of the UK not experiencing strike action from health staff this winter; notes the ongoing £1 billion NHS Recovery Plan, which is supporting new ways of delivering care that are creating additional capacity for inpatients, day case patients and outpatients, including investment to support the four National Treatment Centres (NTC) due to open over 2023; recognises that the expanded NTC network will provide additional capacity of eight additional orthopaedic theatres, an additional inpatient/day case ward, five endoscopy rooms and two general theatres, initially providing over 12,250 additional procedures, dependent on workforce; welcomes the Scottish Government’s draft Budget, which included additional investment to increase adult social care wages, and believes that, through the creation of the National Care Service, there is a real opportunity for underpinning fair work in social care and delivering national sectoral bargaining for social care workers.”

15:12  

Well, after that speech, it is clear that the cabinet secretary just does not get it. Under this health secretary, our NHS is on its knees and is facing a perpetual winter, with waiting times for A and E and cancer treatment at their worst-ever levels. That comes after years of savage SNP Government funding cuts to council budgets, and let us not forget the plans for a national care service, which would scrap local accountability and impose total ministerial control, with the cabinet secretary driving the bus.

Let us look at some of his key performance indicators for the past year. In November 2021, just 75 per cent of patients were seen in A and E within four hours, and we should remember that the target is 95 per cent. If we fast forward 12 months to November 2022, we find that the monthly figure dropped to 67 per cent, which was the worst month on record. More than 13,000 patients waited eight hours in an A and E department, which was twice as many as in the previous November, while the number of patients waiting more than half a day doubled to 5,000.

The situation is so bad that, in January last year, a patient waited more than three and a half days to be seen in A and E. Through freedom of information requests, we have discovered long waits even for people to be triaged in our A and E departments. Now, major hospitals across Scotland are so overwhelmed that they have paused non-urgent elective operations.

NHS Scotland is fantastic because it is full of fantastic hard-working and dedicated professionals. It is the cabinet secretary who is clearly underperforming and who is not providing an effective plan; rather, he has provided what can only be described as a flimsy recovery document.

What do all these numbers actually mean? Let me put it into context for everyone here and everyone who is watching at home, because these are real people. The cabinet secretary says that attendances are down. During the Christmas period, I saw an elderly patient who had significant central chest pain. Because of all the messaging around A and E and the concerns about long waits, she was too scared to go in and instead waited to see me the next morning, when I had to have her blue-lighted in to hospital. That lady has been failed by the system and by the SNP Government.

If the cabinet secretary would like further examples, I am more than happy to provide them. I have examples of children being unwell overnight while the parents were unable to get through to NHS 24; of patients having fallen and lying on the ground waiting for help; and of patients with injuries resorting to do-it-yourself measures. In the real world, where I am seeing patients, people are suffering.

In the winter time, it could be something as simple as slipping on the ice that necessitates your being seen in hospital—a Scottish hospital, which is why deflecting is simply not good enough.

What about patients with time-critical cancer referrals? Waiting times for cancer treatment are also the worst ever on record. In fact, it has been a decade since the SNP last met its target. Let us look closer at this health secretary’s stats. In the third quarter of 2022, just 74 per cent of patients started treatment within the official 62-day standard. We have shocking evidence of a patient who waited two years to start cancer treatment, and also of a six-month wait for breast cancer treatment, a seven-month wait for bowel cancer treatment, and a more than 16-month wait for prostate cancer treatment. That is for cancer.

What about children and mental health? The SNP has never met its target—never. We know that teenagers in Scotland who have been referred to child and adolescent mental health services with eating disorders, suspected attention deficit hyperactivity disorder or autism are being told to expect a two-year wait for a CAMHS appointment. Parents are being advised to go private, if they have savings, at a cost of around £1,500.

In August 2021—

Will the member take an intervention?

—the cabinet secretary committed to clearing waiting lists in both mental health and psychological therapies by March 2023. With more than 8,000 people waiting, that is unlikely.

Will the member give way on that point?

I am afraid that I have no time. Scots either have to sit back—

Will the member give way on that point?

I was very clear, and I think that members should maybe listen. Scots either have to sit back, shut up and wait, or dig deep and go private to get basic healthcare, relieve their pain—

Will the member take an intervention?

—to allow them to function again. Presiding Officer, I have been very clear three times.

Yes, indeed. I think that the member has made it clear that he is not taking any interventions. Dr Gulhane.

That is noted, Presiding Officer—[Inaudible.]

I think that we should just allow Dr Gulhane to resume his remarks.

The SNP and the cabinet secretary will blame Covid, Strep A infections or the flu for the pressures on the NHS today, but the underlying problems that Scotland’s NHS faces are long in the making—long before Covid but during the SNP’s period in government. Failed workforce planning; cutting the number of student nurse places; failure to solve delayed discharges from hospital as promised in 2014—that all predates the pandemic, and we have been pressing the cabinet secretary month in, month out to plan and prepare for this winter. As he knows only too well, nursing vacancies are up 10 per cent this year. There are now 6,319 nursing vacancies in NHS Scotland. In the year to March 2022, more than 7,000 nurses left the NHS. That is one in nine nurses—the highest number of leavers on record.

Delayed discharge is at a record high, and do not get me started on primary care. A BMA survey found that 81 per cent of practices say that patient demand exceeds capacity. We are seeing practices collapse and general practitioners cutting hours or even leaving the profession due to workload pressures and burn-out. Patients are struggling to get the care that they need.

We have a cabinet secretary who is leading the charge to spend £1.6 billion on a national care service that stakeholders fear will result in hyper-bureaucracy, poorer service in remote areas and poor value for money.

Dr Gulhane, you are over your time. May I ask you to conclude, please?

It would be great if I was not interrupted so much.

We would like to see the Scottish Government introduce the kind of steps that we have recommended. Scotland’s NHS is in a perilous state.

I declare an interest as a practising NHS doctor.

I move amendment S6M-07538.1, to leave out from “, and believes” to end and insert:

“; recognises in evidence of this fact that the 62-day cancer treatment target has not been met in a decade, and that the Child and Adolescent Mental Health Services target has never been met since its introduction in 2014, and calls on the Scottish Government to take action by introducing new crisis maximum waiting times, increasing GP capacity by introducing a full electronic repeat prescription system, introducing an NHS care app to allow patients to see live hospital waiting times, introducing prehab for those awaiting treatment, and expanding rehabilitation and assessment in the community and home (ReACH) teams across all health boards to prevent older individuals from having to return to hospital.”

Thank you, Dr Gulhane. I call Alex Cole-Hamilton, who has up to six minutes.

15:19  

Thank you, Deputy Presiding Officer. I am very grateful to Jackie Baillie and the Labour Party for making their Opposition debate all about the crisis in our NHS. I rise to speak on that basis for the Liberal Democrats.

It is hard to remember a time when things were this hard and our NHS was engulfed in such a crisis. Indeed, every new set of health statistics reveals yet another unwelcome record. We have heard so much about that today—it is exhausting. To put it plainly, things have never been this bad. Not a day goes by when I do not receive an email, phone call or visit to my constituency office from someone who has been waiting months for a routine operation, weeks for an important diagnosis or days just to speak to somebody in their local GP surgery.

Every day, we hear more alarming reports from the front line of Scotland’s A and E departments. The huge impact on patients cannot and will not be overstated. We have heard from the Royal College of Emergency Medicine how the dysfunction in our NHS is measured out in human lives. It results in more than 40 preventable deaths each week. Perhaps we should stop for a moment and consider that number. Every one of them is a husband, wife, brother, sister, son or daughter who could have, should have and would have gone home but for the crisis in emergency care.

Just yesterday, I heard the heartbreaking story of an elderly patient who was forced to spend her final days on a trolley in the middle of a busy A and E department. Such accounts are, sadly, becoming familiar, but we cannot afford to become accustomed to them or desensitised to what is unfolding daily in Scotland’s NHS. The stakes are too high. People’s lives are literally on the line.

Neither can we afford to accept the toll on staff. They are on their knees. I saw it this week when I visited a medical practice in my constituency. It is a popular medical practice in a bustling part of our nation’s capital, but it has had an open vacancy for a partner for a year. It cannot hope to fill a locum vacancy when somebody goes on leave.

Doctors have spoken movingly about what they describe as the moral injury that they are suffering from being unable to provide the care that they would want to provide and that their patients desperately need. I know that members speak with one voice in saying that none of that is their fault. On the contrary, we owe the staff a huge debt of thanks for the incredible efforts that they go to and the fact that so many are sticking with it. We are blessed to have them and they deserve so much better.

I turn to the crisis that is engulfing mental healthcare in Scotland. Children and young people still face devastatingly long waits for treatment. Liberal Democrat research has revealed that, since mid 2019, the Government’s 18-week treatment time target has been breached by a cumulative 2.7 million days. The Government says that it will clear up those dreadful waiting lists by March, but they are getting worse by the day. The chances of the Government achieving that goal are, to be frank, vanishingly small.

I absolutely do not deny the pressures in mental health. However, I put on record the fact that recent correspondence that I had with NHS Greater Glasgow and Clyde shows that it is now on schedule to clear its CAMHS backlog by March this year.

There is some really good work, and some achievements are being secured in the NHS. I do not deny the existing pressures, but we should welcome the successes that exist and that are evident.

I am grateful to Bob Doris for that intervention. I salute the efforts of health boards that might be achieving the target, but it is not happening universally. I hope very much that we will achieve it. I certainly want the Government to succeed in it, but it is manifestly clear from the correspondence that I receive that, in Lothian, we are nowhere near clearing those waiting times by March.

The Government says that it will clear those targets by March, but they are getting worse every day and vulnerable young people are paying the price. In previous budget negotiations, my party secured £120 million extra for mental health, but the SNP and Greens have just cut it again by a staggering £38 million. Young people are suffering under the long shadow of lockdown—any specialist or schoolteacher in the country will tell you that. The Government could not have picked a worse time to cut that funding. Liberal Democrats led the way in getting the Parliament to declare a national mental health emergency. Now, the Government needs to step back and give that declaration the funding that it deserves.

In the face of multiple crises, it is natural to wish that someone, somewhere, in a position of power might be working with every breath in their body to make things better. That is what the Scottish people expect of the Parliament and what they hope for, but, sadly, they are faced with an SNP Government that is led by a First Minister who spent the weekend scheming about how best to break up the United Kingdom. She is more interested in which election should be made about her pet project than in ensuring that NHS staff are treated fairly and that patients are seen on time.

Let us get real: one person in six who could not get a doctor’s appointment last year conducted a medical procedure on themselves or got someone equally unqualified to do it. The waiting times for primary care are so bad that it made sense for a Ukrainian refugee to travel home to face the bombs and bullets of her home country rather than the queues of our Scottish NHS. That is the grim reality in Scotland in 2023 under the health secretary, the First Minister and the SNP-Green Administration, and no amount of plotting, scheming or wishing for a future nationalist utopia can hide that fact.

The cabinet secretary accuses others of being out of ideas. If he is open to them, let me offer some. Activate an immediate staff burn-out prevention plan that guarantees better pay and time off when people need it, as well as safe staffing levels. Replace the meaningless treatment time guarantee with real-time information for waits and operations. Reform the funding structure so that dentists can return to taking on NHS patients. Put more counsellors in schools and establish a single point of contact for those young people who are on CAMHS waiting lists. Stop the ministerial takeover of social care and invest the £1 billion that the Government intends to spend on it in services and staff. Finally—

You are over your time, Mr Cole-Hamilton. You need to conclude.

—call a staff assembly that puts the expertise of front-line staff at the heart of solving the emergency. It is an emergency. Get to work, cabinet secretary.

We move to the open debate. Speeches can be of up to six minutes.

15:25  

I speak in support of the Labour motion, because the crisis faced by our national health service impacts on every one of our constituents. As we have seen in recent weeks and months, the NHS’s continued decline is not only a matter of grave concern but a matter of deep regret. The national health service is Labour’s greatest-ever achievement, and I can assure everyone in Scotland that defending it against cuts, neglect and continued decline will always be a priority for our party.

Let us look at that continued decline. As has already been outlined very eloquently by my friend the member for Dumbarton, since the cabinet secretary has been in post, Scotland’s national health service has experienced the worst A and E waiting times on record, the highest-ever number of patients languishing on NHS waiting lists, the worst performance against cancer waiting time targets, the largest increase in levels of delayed discharge and the most vacancies ever recorded in the NHS workforce. That can only be described as a litany of failures—a litany of failures that has devastating human consequences for the people whom we are here to represent in this place and one that, frankly, should result in the health secretary resigning.

I ask Paul Sweeney the same question that I wanted to ask Dr Gulhane, who would not take an intervention from me. A lot of GPs and clinicians at a senior level say that the current situation with their pensions is a problem, which means that they retire early. Would Paul Sweeney be supportive of moves to implement for doctors the same pension arrangement that High Court judges are given by the UK Government, to stop the drain?

I recognise the point that Gillian Martin makes, which I think is very important. When I was a member of the House of Commons, I raised that issue repeatedly in an effort to get the Treasury and HM Revenue and Customs to address the situation. I recognise that that is a cross-party effort. However, pensions are not the single factor that is driving vacancies in the national health service. There are many things that the cabinet secretary and his team could be doing to mitigate and to solve the problems in our NHS workforce. Young doctors and medics, in particular, are going to Australia in huge numbers, and that is not because of pensions.

It is extremely important to reference the human consequences of the failures that I listed. Statistics are released on a regular basis, and I fear that, at times, it is forgotten that behind every one of those statistics is a human being, who is often in tragic circumstances. I cannot be the only member whose inbox is regularly inundated by constituents detailing their harrowing experiences when they call on our NHS services. I make it clear that, in detailing those experiences, neither I nor those constituents are being critical of the staff who work on the front line, day and night, to keep our NHS afloat despite the incompetence of Government policy.

The content of those emails and pieces of correspondence ranges hugely, but one thing that binds every one of them together is that they paint a picture of a healthcare system that is crumbling and failing patients. In November, I was contacted by an ambulance driver who told me that, when he started his shift that morning at 7 am, his first patient had been waiting for an ambulance since midnight. He went on to detail horrendous cases, such as that of a toddler with complex medical needs who was having recurring seizures and had waited for more than five hours for an ambulance. When the crew arrived, the patient’s oxygen level was so low that their condition was deemed to be life-threatening.

In October, while on a constituency visit, I was approached by a constituent who told me a harrowing story about his father, who had suffered a stroke. Because of the delay in getting to A and E on time, because of ambulance shortages, he has been left permanently disabled. When the family asked the cardiologist how severe his stroke had been, they were informed that, if his relatives had got him in a car and brought him up to A and E instead of waiting for the ambulance to arrive within the appropriate timeframe, he would have been left without any permanent complications. Imagine the guilt of that tragedy and the lifelong complexities and burdens.

Just last week, I was contacted by a constituent whose mother-in-law was deemed medically fit to be released from hospital into a care setting in October. She was released on Friday 13 January and was charged £430 for the privilege of an ambulance transfer from the hospital in one health board to a care setting in another.

I could go on all day about the cases that have been brought to my office that show the state that our NHS is in. Every winter, we go through a crisis worse than that which came before. Every winter, we hear details of harrowing and devastating tragedies that could have been avoided. And, every winter, this Government comes to the chamber parroting excuse after excuse. It is not good enough. As much as I respect the cabinet secretary, on this occasion he is in over his head.

We have a workforce that is the best in the world, but it is exhausted and demoralised beyond precedent. The Labour Party has continually called for and argued for an integrated health and social care system, for an increase in social care workers’ pay to £15 an hour, and for a fully funded sustainable workforce plan to be the backbone of this Government’s plans. To date, we have been ignored, accused of scaremongering and, worst of all, accused of talking down the very national health service that this party created. Each of those accusations is not only a grotesque mischaracterisation of our position but a slap in the face for those of us who want nothing more than to see a national health service that is fit for the 21st century, that patients can rely on and that values and cherishes its workforce. On the basis of the current trajectory, under this Government it is unlikely that we will see any of those things any time soon.

15:31  

Every country in the UK has a health service that is under a great deal of pressure at the moment. It is always my hope that we come to the chamber open-minded about policy interventions that we can make, based on the advice of professionals who know what they are talking about and within the budget we have available to us. We must also take into account what patients need from our NHS and, with their expectations in mind, what level of tax they are prepared to pay so that Governments can meet those expectations.

That latter aspect can often be ignored. Warm words abound from politicians about our precious NHS, but how often do we really admit that, to maintain that magnificent thing, the benefits of which Scottish and wider UK citizens enjoy, we must collectively dig deeper into our pockets in terms of tax?

This is the UK conundrum. UK politicians in competition to be the next Government do not want to upset the upper and upper-middle classes and the powerful right-wing press—the kingmakers, as we know that they are—by taxing the better-off. Simultaneously, they want to maintain a façade of cherishing the NHS, even when their actions in government contradict that.

In Scotland, people voted for the SNP and the reforms that we outlined in our manifesto, our approach to public spending on health and our approach to tax—albeit within the limited powers we have in that regard. In my view, the full suite of tax and borrowing powers would give a Scottish Government of whichever stripe the means to protect over the long term the NHS that we want, especially in the face of the erosion of the national health service by successive UK Conservative Governments. In addition, I am sorry to say that the Labour health secretary in waiting, Wes Streeting—

Will the member give way?

I will finish this point. Diane Abbott said of Wes Streeting:

“Inch by inch Wes is trying to push for a privatised/insurance based NHS”.

On the Labour motion that is in front of us, I remain astonished that Opposition parties are not compelled to produce detailed budget plans for scrutiny. As it stands, the public cannot take Opposition proclamations and demands at their word. How might Scottish Labour’s demands for pay for carers be funded? We do not know.

Will the member give way on that point?

I would like to hear the answer to that.

We have outlined over two successive budgets how we would pay for that. I point out to the member the £1.3 billion that the SNP is about to spend on a national care service that nobody believes in. It could use that to fund social care pay.

Well, I have heard of back-of-the-envelope stuff—I cannot see the envelope on Jackie Baillie’s desk, but there we go.

From which other part of the public sector would the Opposition parties take money to put more into the NHS? Again, we do not know. Every week, the Conservatives complain in this chamber about the services that the Scottish NHS delivers, but they wanted the Scottish Government to replicate the tax cuts for the richest that Liz Truss put forward. Had we done so, how would we have maintained the current record spending that the SNP has put into the Scottish NHS? The simple answer is that we could not have.

The Tories in particular love when we compare the Scottish NHS with the service that they run south of the border. It is not just me who is pointing this out: when Sandesh Gulhane was interviewed on “Good Morning Scotland”, he was pressed on the point that if he was calling for the head of my friend and colleague Humza Yousaf over long waits in A and E, he should surely condemn his Conservative counterpart in England, where the waits are longer, the situation is far more precarious in terms of patients being left without care, and investment in the NHS is being stripped out by his colleagues. Let us not forget that the nurses are on strike there today as well.

I have massive sympathy for anyone with responsibility for the NHS wherever they are in the UK. Covid is still causing staff absences and increased admissions. As our health boards warned us, recruitment is suffering because of Brexit. We need better workforce planning, including targeted immigration and action on pensions, as I mentioned in my intervention to Paul Sweeney.

I have to say that I have a smidge of sympathy for Scottish Labour, too, which has been done no favours by its leadership in the past couple of weeks when it comes to health. Its members must have been horrified when Labour leader Keir Starmer played amateur doctor on television on Sunday—[Interruption.] Similarly, they must have been hiding behind the couch—

Ms Martin.

—when Wes Streeting—

Ms Martin! Hello! Could you sit for a second? Could we please have less chit-chat from across the front benches, which is interfering with our ability to hear the member? Please resume, Ms Martin.

Thank you very much, Presiding Officer.

Similarly, they must have been hiding behind the couch when Wes Streeting went to war with GPs, prompting Dr Philip Banfield, who is the UK BMA chair, to say that Mr Streeting

“does not understand general practice”

and that

“the Labour Party has a lot to do between now and the election”.

The Scottish NHS is under the same pressures but, my goodness, our cabinet secretary is working with the sector, negotiating to avoid strike action, providing extra care beds to ease pressures and listening to the professionals.

Across the chamber and across the health and care sector, we are united on one thing, and that is that a great many of the issues in A and E and wards have been caused by poor patient flow, both through and out of hospital. The social care system in its current state needs reform. The Scottish Government is working now to secure more places in care settings for those who are ready to leave hospital. However, radical structural reform is needed in the form of a national care service—a service that, I might add, has the support of Unison and many of the service users we have spoken to in our deliberations.

Alex Cole-Hamilton rose—

Paul O’ Kane (West Scotland) (Lab) rose—

The member is just about to conclude.

This is a chance for us all to come together with ideas on how we achieve that service and eradicate the major cause of the issue that is before us. Let us work together to shape the national care service and make it our whole Parliament’s defining achievement of the sixth session.

15:38  

Our NHS is on its knees. Waiting times for A and E and cancer treatment are at their worst-ever levels, yet more parliamentary time was set aside last week to discuss independence than was spent on our failing health service. As Jackie Baillie stated, it is only in Opposition debate time that we get to discuss the issues in detail.

Today, as one in seven people languishes on a waiting list, I want to focus on waiting times. The real-time impact of pausing and restarting elective surgery is that we never really know the accuracy of median waiting times. All that patients are asking for is clear and accurate data on approximate waits.

Public health data as it is presented shows average waits of 19 weeks. However, that data uses the average median and does not count urgent cases. As Dr Gulhane mentioned, some health boards are not doing any elective surgeries, so it is impossible to deliver a four-week wait.

Patients get angry and distressed when they deal with moving medical goalposts. They have this unrealistic ideal of their waiting time, so they have increased phone contact with their GP and make more calls to hospital secretaries as they wonder where they are on the waiting list. All of that adds to the daily pressures that our front-line staff are facing.

Lauren Bennie, Scotland head of Versus Arthritis, said:

“People need clear and regular communication about when they can expect to receive surgery and what information and support is available while waiting. Many fear being forgotten or feel abandoned to manage their pain alone.”

Sue Webber has outlined eloquently the reality that many of our constituents face. They are given letters that say that their treatment will begin in 12 weeks when there is not a hope in hell that they will be seen within 50 weeks. People make life plans based on those letters; they agree to attend weddings overseas or put off holidays in the hope that they will be seen. We need to make sure that patients are seen in real time. Does the member agree?

Yes, I agree.

I will continue to quote Lauren Bennie, who said:

“The difference between a 33-week wait and a 19-week wait can be devastating for people”,

as Alex Cole-Hamilton just outlined, especially those

“with arthritis whose physical and mental health are worsening by the day, slowly eroding their independence. Edinburgh University researchers found that people’s quality of life significantly deteriorates after each six-month period of waiting.”

People with arthritis who are waiting for hip and knee replacements live with severe pain, struggle to move around and are often unable to work. In terms of healthcare economics, those operations are some of the most effective treatments that the NHS offers, so it is unacceptable that people face long waits or financial instability to access them.

We increasingly hear from people who feel that they have no choice but to use savings or borrow to pay for surgery privately. The financial hit is especially devastating when living costs are soaring. Before I get any interventions, yes, that risks widening health inequalities further and thus has to change.

We must remember that pain is crippling and debilitating. People have little or no confidence in any practical steps to reduce the impact of their pain on their daily life. Reliance on pain medication is very high, and a lot of self-management resources have been suspended due to the pandemic. Medication options, from prescription to over the counter, take a toll, too—from fatigue to nausea and, dare I say, constipation. They, too, impact on the ability to work and have a normal life. We call on the SNP Government to introduce prehab for people awaiting treatment, so that people can live well while waiting. Reliance on pain medication is very high and impacts the quality of many people’s lives.

The cabinet secretary told us that all would be well when he brandished his NHS recovery plan in August 2021. He then claimed that everything was under control when presenting the winter resilience plan in October. Now he has been forced to concede that everything is far from well.

Rather than work collaboratively with other politicians who have plenty to offer in what is undoubtedly a national emergency, on Tuesday of last week, Mr Yousaf was utterly dismissive of the Conservative NHS action plan, which was produced by someone who knows what they are talking about. The Scottish Conservative’s 14-point recovery plan includes streamlined specialist super Saturdays, the expansion of same-day operations and more off-peak scanning.

My colleague Dr Gulhane is a practising doctor and a former orthopaedic registrar. As he said, he spent the holiday touring practices to get a genuine feel for what is happening across the country. I have spent more than 25 years working with healthcare providers in Scotland, England and Northern Ireland.

The SNP has spent years hollowing out our local councils. With savage funding cuts on the horizon, its plans for a national care service would scrap local accountability and impose total ministerial control.

Will the member take an intervention?

The member will be concluding shortly.

I am in my concluding remarks.

Last week in his statement, Mr Yousaf admitted that

“it is right for health boards to retain decision-making at local level so that they can determine how best to flex their services”.—[Official Report, 10 January 2023; c 37.]

Perhaps his Government should heed his own advice when it considers wasting £1.7 billion on ripping social care from local authorities.

15:44  

I, too, put on record my gratitude to all who work across our NHS and care sector in whatever capacity.

I now address the Labour motion. It would have more heft if it at least mentioned, if only in passing, the devastating impact of Covid and the years to follow when the NHS throughout the UK and healthcare throughout Europe and the wider world dealt with a raging pandemic and adapted procedures in the face of the virus, which brought what I might term the usual provision of healthcare to a standstill.

The motion also does not recognise that it will take years for recovery. To this day, sanitation is high, mask protection continues and ambulances have to be sanitised after every patient. All that adds to delays, and Covid still stalks hospital corridors. Add to that the pressures of influenza—not mentioned by Labour—which can be very serious and, despite vaccination, is possibly proving more so to some groups of people, including me, because we have reduced resistance after years of wearing masks and sanitising our hands.

Then there is the welcome but extra pressure of the demographic shift, which also went unsaid in the Labour motion. We all live longer, which is a good thing, but age naturally brings additional demands on our health services and care sector. Wherever we look in the UK, the issues remain the same. Indeed, the situation is worse in Wales—where Labour is in government—than it is in England under the Conservatives. I do not say that with even a slight degree of satisfaction—not in the least—but do so simply to put today’s debate into context.

Also for context, I say that, in my 24 years as an MSP—during the Labour-Liberal Democrat coalition and to date—much of the attention has been on firefighting the increased demands on the NHS. Some good progress was made, and I welcome free personal care under the Labour-Liberal Democrats, and, of course, free prescriptions, free school meals for those in primary 1 to primary 5 and the child payment, all of which are interventions made under the SNP Government that are aimed at reducing NHS pressures. In England, it costs more than £9 per item prescribed, and therefore some people who live south of the border are rationing their medication to the endangerment of their lives let alone their health.

The problem is, as it always has been, how to move from the immediate demands, which are exacerbated as I have narrated, to a medium to long-term solution. I therefore welcome this suggestion by the British Medical Association:

“BMA Scotland is calling for a National Conversation with all stakeholders, to take a long-term approach to what we want and expect from our NHS. Only when we fully understand what we need and want from the NHS can proper consideration be given on how we resource it.

The National Conversation, commissioned by but independent of the Scottish Government, would act as a facilitator for a dialogue between the public, health and care stakeholders, Scottish Government and political parties; its purpose is to inform the reform, it must have practical outcomes that are part of a long-term vision for NHS Scotland.

Now is the time to seriously consider what the NHS provides within the resources we provide it with, and ask the difficult questions around what we as a society want from a National Health Service free at the point of need, what we can afford to deliver and how we deliver it. There are no easy answers.”

I agree.

Covid was a wake-up call for all of us to the growing needs of those who receive care at home or in care homes and the varying standard of that care; integrating health and social care; the standardisation of care provision; recruitment and retention; and the expanding use of pharmacies and allied health professional services so that the right treatment is provided at the right time by the right health professional. All of that is not easy, as the BMA stated.

Does the member agree with me that, although care is critical, resourcing it also essential? The disproportionate cuts that have been imposed by the Government on local government have only exacerbated the delayed discharge problem.

I will come on to resourcing.

During this thoughtful discussion, we should consider the following questions: what is the role of health boards? What should the relationship between GP practices and health board areas be? Should more GPs be directly employed by the NHS rather than in private practice? How much more can technology be used? What should the state provide in the care sector? What kind of workforce do we need and where do we get it when some options are closed because of Brexit? What will be required as our ageing population increases? How does our society afford expensive treatment and drugs? What price do we put on all that, and how do we fund it?

This is the only party-political thing that I will say: as a result of the disastrous and costly funding of public buildings, including in the NHS, using the private finance initiative under Labour, the cost each year to the Scottish Government in repayments to the private sector on NHS buildings alone runs at £250 million, which could have been better spent on services.

It is the job of the Opposition to hold the Government to account, but too often that is with press headlines in mind. Opposition members must offer solutions and, most importantly, credible funding sources from what is virtually a fixed budget, now reduced in value by £1.4 billion due to inflation.

I say to members in the chamber: less heat and more light, please. Turn down the volume on theatrical rhetoric; turn up thoughtful and responsible debate. That is what the Scottish public want.

15:50  

Our NHS is in crisis, and we urgently need an NHS recovery plan, as Jackie Baillie has said. I agree that Covid has had a massive impact right across public life, including on the NHS, but we cannot pretend that the problems in our NHS are not long term and deep seated.

In Lothian, up until the first lockdown, the Scottish Government’s target to have 95 per cent of patients admitted, discharged or transferred for A and E treatment within four hours from arrival was last met in October 2017. This is an on-going challenge and we need to look at the issue of staff investment in terms of doctors and nurses and, critically, in terms of care staff, who will not be attracted to a profession where not only is the salary lower than many in other jobs but the job is significantly more stressful. It can often require people to pay for their own travel costs to support clients, and carers are not getting the career development opportunities that we should be giving them. That is why we need the national terms and conditions and decent career opportunities that Jackie Baillie talked about—not a bureaucratic, centralising organisation that will strip yet more investment from our cash-strapped local authorities, which are on the front line, trying to provide care for our communities.

When we look at NHS staff, we need to focus not just on this year’s pay negotiations, although those are critical to making sure that staff get a decent reward for their work. We also need to ask what more can be done to support staff retention. The pressures in the NHS in terms of understaffing and the stress that many staff are facing need to be addressed now.

The eye-watering length of time that people have to wait for treatment is not just affecting members of the public; it is also affecting those staff who cannot continue working for the NHS because they are waiting for an NHS operation or treatment.

When I recently met NHS Lothian staff members, it was heartbreaking to hear about their personal situations and to pick up on their anger about the use of agency staff when they would rather have full-time, permanent NHS staff doing that work. There are key challenges that we need to address.

I want to say something about the long-standing backlog of challenges. In NHS Lothian, a lot of our problems are due to systemic underfunding. The national resource allocation formula has not been delivering sufficient investment for years and, in Lothian, we have a growing population and we will continue to see more people needing support in the future. Our projected net population growth is 84 per cent of Scotland’s projected net growth. We need a discussion about that now, because we will get more young people, but we are already getting an ageing society, as Christine Grahame has just mentioned.

NHS Lothian needs that support now because, as I understand it from the helpful briefings that we get from the staff who are running those services, the services in Lothian are already at capacity. That is before that population increase, so we urgently need investment in staff to keep the services going. We also need new buildings, such as the eye pavilion, but there are other key investments that we need and which need to be factored into an NHS recovery plan to create the investment, to tackle the projections and to make sure that we can provide services now and that we have confidence for the future.

A particular issue that Jackie Baillie rightly finished on is the need to focus on preventative care, because access to our GPs and to community healthcare services is critical but, last year, our GPs saw significant cuts from the Scottish Government. That does not help because, in Lothian, we need capacity increased not just in our hospitals but in our communities.

Day after day, people phone my office who are struggling to get GP appointments and there are lengthy phone waits. They have to phone day after day, because there are simply not enough appointments available. That means that underlying health problems go untreated, which is a disaster for people as potentially dangerous symptoms do not get picked up. For example, symptoms of cancer do not get treated. As we know, swift treatments, with the fantastic services that we have in the NHS, can save people’s lives and give them different outcomes. That is why people are going to A and E, because they are desperate to get help when they need it, especially when they have experienced pain day after day and have waited weeks to get access to support.

We need more information. Last week’s briefing on the survival of cancers was impactful. Making sure that people get access to our GPs is critical; we can then get them access to operations and the treatment that they urgently need.

In his summing up, I want to hear from the cabinet secretary what action he is taking to prioritise additional investment in GP services across the country, particularly community access, with a focus on Lothian, not forgetting the current crisis in that region that is getting worse. Day after day, people are frustrated and upset; they are stuck in hospital waiting for operations that they urgently need. This week, someone approached me who needs to go to another health board for an operation. However, they are stuck in a bed in NHS Lothian, which is not what they want. They do not just want the operation; they also want not to be blocking someone else from getting access to their bed. People cannot go home, because the care that they need is not available, and there is not enough step-down care in care homes either. We urgently need action. Investment in preventative care is critical.

I would push back on the SNP members’ comments when they say, “We are not being party political.” The SNP has been in power for 15 years. The crisis in our NHS is of long standing and is due not only to a lack of investment but to a lack of correct priorities. Prevention is better than cure, but we are getting the opposite of that. We do not need social prescribing in three or four years’ time when we do not have the cultural organisations—

Ms Boyack, you need to come to a close, please.

We need action and investment now.

15:57  

It is an inescapable fact that the pandemic is, as it has been for healthcare systems across the world, the greatest challenge that our NHS has faced since it was created 75 years ago. I am not sure how Labour has managed to square the circle in its motion, in which it claims that the pressure on the NHS in Scotland is not caused by “short-term” issues, but also claims that those issues must be addressed by a recovery plan. There is, of course, an on-going recovery plan that has been funded with £1 billion, because our NHS needs to recover from what the Labour Party calls “short-term” issues.

Labour has its fingers in its ears, but the current issues that we are facing are enormous, so it is inevitable that there will be some effect on the NHS and its workers. Those issues include Brexit, which has seen us lose so many of our staff who no longer feel welcome in the UK, thanks to decisions that were made down south. They include the Covid pandemic, in which—even putting aside the current high number of cases—thousands of people who would otherwise have been well have been admitted to hospital, struck with long Covid, or otherwise made weaker as a result of catching the virus. They also include, of course, the Tory-made cost of living crisis, which is pushing people into poverty-related health issues and putting pressure such as I have never seen on budgets, thanks to overwhelming inflation.

Those issues have widespread and long-lasting effects that cannot be ignored, and they certainly cannot be separated from the significant pressure that exists, as Labour highlights, in the NHS.

Emma Roddick is seeking to outline a number of the challenges. However, does she accept that clinicians are saying that the current situation has been 15 years in the making, and that the issues that the member is relaying to the chamber are exacerbating a situation that was already extremely difficult because of decisions of the Scottish Government?

I am not sure which “clinicians” the member is referring to, but there is certainly work going on.

In looking at the Scottish Government’s amendment to the motion, I see no denial that there are problems within the NHS. I will come on to the difference between how those problems have been dealt with in Scotland and what has been done down south, because the context and issues that I have outlined exist in the rest of the UK, too, so what matters most is how the relevant Government chooses to react and how the issues are dealt with.

In Scotland, the SNP Government has eased delayed discharge by purchasing additional care beds and providing additional support to NHS 24. It has got round the table with unions and made the offer of a 7.5 per cent pay rise for agenda for change staff. We can compare that to what the UK Government has done, which is to disrespect unions and table legislation to prevent folk from going on strike.

Perhaps the different tack that is being taken in Scotland is why we have the best-performing A and E service in any of the four UK nations, and perhaps the fact that we have the best-paid staff in the UK and make the time to sit and talk and negotiate with them is a big part of why we are avoiding strike action here today, unlike other parts of the UK.

Perhaps Labour could look at the bigger picture and think about the contrast between the two systems that are on offer and the positive change that has been made here, and, rather than coming here and making claims about the NHS being on the point of total collapse, make actual costed and reasonable suggestions, and back us when we demand more freedom with the budget, which would allow us to make even more progress even more quickly.

Will the member take an intervention?

No—I am sorry.

I used to be a carer. My wee sister is still one—and a far better one. I would love to see more support for carers, and I know that the incredibly ambitious national care service will make the massive changes to their experience that are needed. Labour seems to be both demanding that we spend money that we do not have and complaining about the money that it is planned will be spent on the national care service. It wants us to spend more money, but not on that, even though the service is backed enormously by the public.

The increase in adult social care pay this year to £10.90 an hour is part of a 14.7 per cent increase in the past two years, and is the same as the Labour Government in Wales is offering. To offer more “overnight”, as Jackie Baillie asked for earlier, would require greater fiscal powers and/or the cutting of budgets elsewhere. Even increasing pay for care staff to £12 an hour would cost the Scottish Government hundreds of millions of pounds.

We have been asking for that for some time now. It is not an overnight request.

Does the member agree that £10.90 represents only a 3.8 per cent pay rise during what is an incredible cost of living crisis, and that band 3 NHS workers have got significantly more. Does the member not think that they should get the same?

I was quoting Jackie Baillie’s earlier contribution when I used the word “overnight”. I do not think that anything that she has just said is in conflict with how I presented it.

It is a real shame that we lack access to the levers of power that are required to address the issue fairly, and that Labour—even after the Tories tanked the economy last year with their irresponsible UK governance—is still failing to back calls for greater power. We should not be tied to public spending decisions that are made by a Conservative Government in another country. We should be able to borrow where we see fit in order to react to events and fund our NHS properly, because the Government here in Scotland wants to protect the NHS. It does not want to let privatisation in and it is not focused on cost cutting more than on good public service.

We cannot keep relying on the promises of an irresponsible flip-flopping Government elsewhere, given that last year showed us that we cannot rely on its block grant figures from one month to the next. If we had employment powers here, we could defend workers against the attack that is being made on their rights through the introduction of the most restrictive anti-trade-union laws anywhere in Europe.

I wish that we could be debating today a greater vision from Labour—one that involves protecting and strengthening employment rights, rather than merely hearing that we should put more money in and do it quickly, without any indication of where in the fixed budget that money would be taken from.

The Scottish Government funds the NHS to a proportionally higher level than other Governments across the UK fund it; it will continue to do so, all the while keeping that public service in public hands, with public accountability.

16:03  

I start by thanking Labour for giving us the opportunity to discuss the national health service. I do not agree with everything in its motion, but I am grateful that it, like us, wants to concentrate on this subject, which is—dare I say it?—close to my heart and has become very personal to me over the past year.

Let us consider some of the problems that we are facing across Scotland, and let us turn the spotlight on the Highlands.

We know that, in December, across Scotland just more than 50 per cent of A and E patients were seen within a four-hour waiting time. That is the lowest figure ever recorded. The crisis in A and E has extended outside that department and on to the ambulance park. For the first time in the Highlands, we have seen ambulances that are carrying patients who are in need of treatment waiting outside hospitals. Furthermore, some ambulances have been deployed with only one member of the crew in them. The First Minister admitted that there were about 1,400 instances of single-crewed ambulances being deployed.

Obviously, we do not want any instances of single-crewed ambulances, but will Edward Mountain accept the Scottish Ambulance Service figure that well over 90 per cent of ambulance call-outs are double crewed? Although it should not happen, single crewing happens in a minority of call-outs. The overwhelming majority of call-outs are double crewed.

I absolutely accept that point, but if the cabinet secretary was stuck on the A9 in a car, and a single-crewed ambulance turned up to collect him, I bet that he would wish that there were two people in that ambulance, so that he could not only be treated but taken to the hospital.

Let us look at other issues, such as the pre-hospital immediate care and trauma—PICT—team, which was going to be disbanded. That was a group of doctors who were working seven days a week, on the ground, to deliver care outside the hospitals. They were the only ones who were capable of dealing with patients who were stuck in ambulances on the forecourt because, according to convention, A and E doctors do not go out to ambulances. The PICT team doctors could go out, but it looked as though the team was going to be cut.

What about the other people whom we really want to see—our GPs? There has been a big fall in the number of GPs and an increase in demands on them. Miles Mack, who is one of the GPs in the Highlands, has warned about the challenges of recruiting GPs across the Highlands. It is really difficult. I know of at least three GP practices in the Highlands that have only one GP. What happens when that GP is sick? The other day, I met a constituent who has waited 12 weeks for a telephone appointment. They said to me that they are desperate for the telephone appointment because they want to get on another waiting list. They told me—these are their exact words—that they felt that

“it would be easier to get a face-to-face appointment with the Pope”

than it would be to get one with their GP. We should not be in that situation.

Let us look at Caithness. In 2016, there were 250 births in Caithness general hospital. The cabinet secretary’s Government centralised the maternity service so that, apart from very few, all births now take place in Raigmore hospital. Last year, 180 births took place in Inverness and only 10 in Caithness. Of those 180 births, more than half were induced. Is that how we want to go forward? Is it down to the shortage of staff or the fact that we are not providing what we need?

If we look at the orthopaedic figures, we see that 2,569 patients are waiting for orthopaedic surgery. Research from Aberdeen suggests that those patients might have to wait seven years for treatment. That will not be solved by the national treatment centre, which the cabinet secretary mentions in his motion and is delivering two years late and over budget. It is still not fully staffed—20 per cent of staff are still to be found. He said that, when the centre is working at full capacity, it will deal with approximately 2,000 cases a year. We have that many cases in the Highlands, but that is a national treatment centre. We should never forget that the national treatment centre will deal only with the easy orthopaedic cases—not with the difficult ones that have been waiting for four years and whose hips and joints are damaged because they have waited so long.

Therefore, the national treatment centre is not all that it promises to be. According to the figures that I have worked out, 868 patients will have to travel outwith the Highlands, either to Aberdeen or the Golden Jubilee hospital, in order to get the treatment that they need. Of those, 184 patients have been waiting in excess of three years. That is the state that we are in, and it is completely unacceptable.

The Presiding Officer will be tight with my time, so let us look very briefly at another area. There are more than 700 children on the waiting list for neurological development assessment. The maximum waiting time for treatment is meant to be 36 weeks, but that is just in the cabinet secretary’s mind—the staff estimate that it will take two years. Unacceptable pressure is being placed on them by mismanagement. I think that that is unacceptable and will, without doubt, result in bullying, because people are being set unrealistic targets that they cannot achieve.

I believe that this Government has a lot to answer for when it comes to the state of our national health service, which I am really proud of and passionate about protecting.

Cabinet secretary, I have said to your two predecessors—

Mr Mountain, you need to conclude.

I told Shona Robison and Jeane Freeman that it was time for them to go if we wanted to protect the health service, and I say the same to you. Your time is up, cabinet secretary—you have failed us and you are a disgrace.

I remind members that they should address remarks through the chair. References to “you” are, in fact, references to me. I am sure that that is not what the member was trying to say.

16:10  

I will give a summary of my most recent personal—[Interruption.]

Mr Mason, please sit down for a second.

Could we have less sedentary commentary from across the chamber? We need to hear the speaker who has the floor, and that is Mr Mason.

Thank you. I will give a summary of my most recent personal experience of the NHS. On Saturday afternoon, I went to visit my very elderly aunt in hospital, which happens to be in the Ayrshire and Arran health board area. I was there for only a short time, but the whole experience was welcoming, friendly and relaxed. Someone came and let me into the ward even before I had had the chance to press the buzzer, I was directed to my aunt’s ward, and a seat was brought beside her bed for me to sit in.

It was a lovely bright ward with lots of daylight, and it had just six patients in it. I could see the staff chatting to other visitors as well as to the six ladies who were staying there. When it was time for tea for the patients, the staff sought to interact with my aunt, helped her to drink it, went and got more milk when she said that it was too hot, and did all that I would have expected and hoped for, and in a warm, friendly and relaxed way. What a good advert for the NHS and, in this case, for Ayrshire and Arran.

No one is denying that A and E is facing challenges; no one is denying that elective surgery has been suspended in some cases; and no one is denying that GPs are under extreme pressure. However, let us not make sweeping and false declarations that the whole of the NHS is on its knees and that the whole of the NHS is broken—that is most certainly not the case. Many parts of the NHS are working extremely well and are fulfilling the roles that they were designed to do.

I note the member’s comment about sweeping generalisations and his previous comment during an intervention about exaggeration. Will he clarify whether he agrees with the clinicians who are saying that the NHS is struggling and suffering and is on its knees?

I thought that I had been clear, but my point is that some parts of the NHS are clearly struggling and some parts are doing incredibly well. It is a mixture; it is not one picture.

I do not think that exaggeration and bringing up the most extreme individual cases serve Opposition politicians at all well. We will do ourselves and the country a better service if we discuss these challenges in a serious and sensible way, especially if we focus on what practical steps can be taken.

The Labour motion says that the crisis in parts of the NHS

“has not been caused by short-term problems”.

In fact, it has been caused by a number of things, both longer-term and shorter-term. In the short term, we have had Covid, which has been like a major injury or accident to our health system. When a person has a serious accident or operation, it can take them a long time to recover and fully regain their strength. In the same way, Covid was a major blow to all of our health systems, and it is taking all countries time to recover.

I fully accept that there are longer-term problems, including, for example, overall UK funding for the NHS. The UK is spending 39 per cent less per person on healthcare than Germany is, and 21 per cent less per person than France is. Those figures were highlighted in the New Statesman last week, and I understand that they are based on the Organisation for Economic Co-operation and Development figures.

That UK underspend on health is the result of Conservative and some Labour Administrations at Westminster peddling the idea that we can have high-quality public services while reducing the amount of tax that everyone pays. I am afraid that that is just not possible, so now the chickens have come home to roost. Lower taxes mean poorer health and other public services.

Health is devolved in Scotland, and we can vary income and other taxes to some extent in order to gain more funds for the NHS; however, we are constantly warned that we must not stray too far from UK tax rates in case every better-off person moves south, so we can only really vary health investment to a limited extent.

There is certainly no way that Scotland can make up the 21 per cent funding gap with France or the 39 per cent funding gap with Germany.

Will the member take an intervention?

I am sorry, but I have taken an intervention already and I do not think that I have time.

We are looking at a UK funding problem here, not a Scottish one—it is certainly not only, or even primarily, a Scottish problem.

Let us remember that, in recent years, Labour has repeatedly told us in budget discussions that we should be funding local government better. Broadly, that means giving the NHS less, because those are our two main areas of expenditure in Scotland. Therefore, Labour cannot have it both ways.

Will the member take an intervention on that point?

I am sorry, but I do not have time; I have one minute left and I have a huge number of important things to say.

Either we have been giving the NHS too much funding and local government too little in recent years, or we have been giving local government too much and the NHS too little.

We see in Labour’s motion the idea that we should focus more on preventative healthcare. Absolutely—I think that everyone here agrees that we should do that. However, the problem is that no one here has come up with a workable plan as to how we would do that in practice. Again, it is a question of choices and where we disinvest to find the funds to invest more in areas of prevention.

We have seen the tragedy of the air crash in Nepal this week. Members might know that I lived and worked in Nepal for three years. When I think of the health services in that country in comparison with what we have here in Scotland, it is like night and day.

We tend to forget how fortunate we are in comparison with most other countries in the world. If we want to maintain and improve that position, and the UK wants to match countries such as Germany and France, we must have a serious adult debate about what we want and how we will pay for it. That should not be just among ourselves as politicians; we must engage the wider population of Scotland. Do we want to be a low-tax country with a declining NHS, or are we prepared to pay more for the quality NHS that I want to see?

16:16  

Before Christmas recess, we all noted in the chamber the strain that could be brought on the NHS over winter. Sadly, we are now seeing the reality of that played out in our hospitals across the country.

We need to tackle the current issues and ensure that we build in future resilience. We must plan services by anticipating demographic change. In addition, we must do the work now on preventative care and public health, to help people avoid becoming sick in the first place and to stay as well as possible if they have a health condition.

In the current period, the on-going work on recruitment and retention needs to gather pace to ensure that services are fully staffed and that patients are seen in a timely manner.

Some of that is undoubtedly about pay and I am pleased to see the progress that the cabinet secretary has made with unions. I hope that talks can be resolved in a way that is acceptable to all.

The member mentioned pay. We know that pay in the social care sector is an extremely important issue, as my colleague Jackie Baillie outlined. In the Green manifesto, the party was committed to paying £15 an hour for social care workers. Why did that disappear in the vaunted Bute house agreement?

That commitment has never disappeared from our work in government. [Interruption.] The difference between the Greens and Labour is that we are in government, working as hard as we can to push for uplifts, of which there have been several in the past year. [Interruption.] While Labour continues to shout from the sidelines, we will continue to do the work in government.

As well as hearing about pay, I regularly hear about working conditions in meetings with unions and NHS workers. Some of the issues and pressures are health board and, sometimes, hospital specific; others indicate wider issues.

Many in the chamber will be aware of a story that broke in NHS Forth Valley in my region, where one nurse was left to support 37 patients on their own. The scale of that is, I hope, an extreme example.

The implementation of safe staffing legislation is essential to ensure patient and staff wellbeing. The cabinet secretary has previously set out to Parliament steps that were under way and I ask that whichever minister sums up gives an update on the situation.

To boost retention and ease pressure, recruitment is, as I said, essential. We need to allow staff the time to take breaks, to go home on time and to ensure that they do not have to take on extra shifts when they are already tired.

I hope that the UK Government will listen to the suggestion that I put to the cabinet secretary last week on fast tracking visas for international workers coming to the Scottish NHS. That could allow faster access and provide a more attractive option to those workers who were put off by Brexit.

Work in the Health, Social Care and Sport Committee has highlighted that people do not understand all the pathways that are available to them. We have to be explicit with patients as to what treatment options are available. Changing the way that people view their healthcare is not always a quick process, but we need to advertise all the different routes well.

At the moment, it is essential that the diversity of urgent care in particular is well understood. I hope that we can collectively support services such as GP out-of-hours services, which are staffed by passionate people who often have other commitments, too. With the strain that we are seeing across the health service, there is a real danger that we will rely on a dedicated few or risk seeing the service eroded.

I hope that in the future we can also see more digital offerings from NHS 24. Not everyone is comfortable speaking on the phone, and some cannot. Some people find waiting in long queues on the phone difficult—for example, if they have multiple caring responsibilities. A chat function might be more suitable for some, and I hope that that can be explored.

In the medium term, the treatment backlog that has resulted from the pandemic will continue to need to be addressed, even after the peak of winter pressure. Across the chamber, we are all aware that three health boards have taken the decision to pause elective surgeries, and I hope that that can be for as short a time as possible.

Many people have also seen their conditions progress more quickly because of restrictions and not being able to access services that had to be shut for public health reasons. We need to make sure that those who have had their operations or treatments postponed are well informed.

I hope that the capacity that has been brought in by national treatment centres can also help with waiting lists. I am always grateful for information from the cabinet secretary on progress and the details of that.

For the long term, we also have to consider what services will look like in the future and to plan for that now. There is a danger that, in the midst of increased pressure, we recruit to plug gaps without forward thought. Patients want to have more services delivered locally. We have seen a move towards that through the development of the hospital at home programme, and statistics show that more people want to die at home. Given our ageing population, that means that more palliative and end-of-life care is delivered in people’s homes instead of in hospital. That presents its own challenges for the primary care and social care workforces, where district nurses, social care workers and GPs are often on the front line. The need for recruitment across the health service now is clear, and we need to ensure that the mix is the right fit for what we would like to see from healthcare.

We should be making the move towards preventative health spending and keeping people well from the outset. That is not to say that all ill-health can be prevented—that would be too simplistic a viewpoint—but preventative spend saves time in hospital and saves costs at the acute end. I say to Mr Mason that it does pay for itself eventually. Preventative spend should also cover mental and physical health and be appropriate for whatever impairment or health condition a person already has. I recently met some amazing school nurses in Falkirk who are carrying out preventative work. I encourage everyone to speak to school nurses in their area.

I will end, as others have, by thanking all those across health and social care who have worked relentlessly, not just this winter but over the past number of years, to ensure that those who need care can get it.

16:23  

The public health challenge that Scotland faces as a result of the global Covid-19 pandemic is unprecedented. Over the past two and a half years, the pandemic has had a significant impact on the health and wellbeing of individuals, families and entire communities across the country. That cannot be ignored. It increased the demand for social care services, shone a light on the health inequalities that exist across the population and changed the way that every person lives their life.

Covid recovery will take years—it is naive to think otherwise. The coronavirus pandemic has impacted our health both directly and indirectly. It has caused direct and tragic harm to people’s health, affected our broader way of living and our society, impacted on our economy and had a hugely damaging effect in terms of poverty and inequality. Our energies have been focused on how to adapt to the changing needs of our healthcare system. Although national and local government, NHS boards and other partners have worked tirelessly to address those problems, it would be delusional to suggest that the impact of the pandemic is not still a factor in the problems that our NHS faces.

I have said this before in this chamber, and I will say it again: although it suits Labour’s narrative to stand here and criticise Scotland’s NHS, it is not just in Scotland that healthcare staff and services are under strain. The NHS in every part of the United Kingdom faces significant pressures. Although our performance can be improved upon, our accident and emergency departments continue to perform better than those in England, Wales and Northern Ireland. Dr Gulhane mentioned the November figures. Scotland’s core A and E units were 9.2 percentage points better than those in England, where the Tories are in power, and 6.3 percentage points better than those in Wales, where Labour is in power. Despite what Labour would like us to believe, the reality is that the entire country is still reeling from the shockwaves of the pandemic.

Will the member take an intervention?

I will not take any interventions from Labour Party members. They should listen to my comments on the legacy of their time in power, which is still affecting the NHS.

The cabinet secretary and the First Minister have set out the action that the Scottish Government is taking to improve A and E waiting times. The £50 million urgent and unscheduled care collaborative will help to implement a range of measures to drive down A and E waiting times. That will include offering alternatives to hospitals such as hospital at home, directing people to more appropriate urgent care settings and scheduling urgent appointments to avoid long waits in A and E. The £600 million health and care winter plan will support the recruitment of 1,000 additional staff. The Government is delivering £45 million for the Scottish Ambulance Service to support on-going recruitment and service development, and there is £124 million to assist health and social care partnerships to expand care-at-home capacity. Those measures do not sound like a lack of action to me.

In December, it was announced that the health and social care services would receive their highest-ever budget settlement in the next year. That is paving the way for sustainable public services in Scotland with a £19 billion package that helps to tackle the immediate pressures caused by the pandemic and the tough winter while supporting the delivery of health and care services that are fit for the future. Once again, that commitment does not seem to show that the Scottish Government is not fully aware of the importance of supporting our health service and its staff.

There is another pressure that health boards face—one that is inflicting a great deal of damage across the country—but somehow I do not think that we will hear about it from any of the Labour members today. Maybe that is because they have very short memories when it comes to public finance initiative and public-private partnership contracts. People in Scotland are still paying the price for Labour’s shameful PFI and PPP contracts for NHS buildings, with the Scottish Government paying more than £250 million every year for contracts that were agreed under previous Administrations. That is a staggering amount. Just imagine what that money could do to support our NHS services.

I have seen the effect of those damaging agreements locally at Victoria hospital, in my constituency. The hospital was built at a capital cost of £170 million but, by the end of the 31-year contract, NHS Fife will have had to pay £887 million for it. I will say that again for my Labour colleagues: the cost is £887 million for that hospital, which is a disgrace. Labour’s PFI legacy will long be remembered by the people of Fife and beyond. Labour’s ill-advised PFI deals have left the Scottish Government paying enormous sums that are above the odds for our hospitals and schools. That money would be much better spent on front-line healthcare than on paying the cost of Labour’s mismanagement.

The consequences of Mr Brown’s only-game-in-town public sector borrowing fiasco could almost be forgiven if lessons had been learned, but the Labour Party has learned absolutely nothing from its toxic legacy and wants to keep the door open to the Tories increasing private sector input in our precious NHS. It is really no surprise that the people of Scotland do not trust Labour any more than they trust the Tories. Rather than stand here and have an honest debate about Scotland’s NHS while acknowledging that these important issues are being faced by every health service across the UK, Labour members ignore the inconvenient facts that do not fit with their rhetoric and seek soundbites with which to attack the Scottish Government.

There are problems that must be tackled and challenges that require long-term solutions—no one denies that—but I, for one, am thankful that the Scottish Government is determined to continue to take real action to address the problems that are faced by our NHS and its staff and to alleviate the pressures that are being felt by our services. A whole-system approach is the right way forward as we progress through this critical period and look towards the future—a future in which health and care services ensure that everyone gets the care that they need, when and where they need it.

16:29  

I will come at the issue from a slightly different angle. I will never forget that it is thanks to our NHS that my husband is alive. The care and attention that he received were fantastic, and I will be eternally grateful to the surgeon and all the staff who worked to ensure that my husband could come home.

That is what everyone wants, isn’t it? People want to get on with their lives as best they can, safe in the knowledge that, when they need professional medical help, it will be there for them. They want the stress, strain, pain and trauma of the experience to be minimised and they want to know that they or their loved ones will be treated in a safe, speedy and sympathetic manner so that they can return to their lives as soon as is humanly possible. I know that my husband received that care, but I also know that we were lucky. I know it because I was told it. I was told it on four separate occasions, by four different medical professionals, for four different reasons.

First, the emergency services telephone operator told me that because we had an ambulance with us within 20 minutes instead of having to wait more than eight hours. The paramedics told me that because they had just finished a local call and had not gone anywhere else when the request came in. The emergency doctor told me that because the Covid lockdown meant that there were reduced numbers of patients in A and E. The psychologist who helped my husband over his depression told me that because a psychologist would not usually be assigned but was assigned because our family could not visit the hospital. That is not the case for many, who do not have luck on their side.

My husband was a grown man who was experiencing a mental health issue that was brought on by a stroke. Imagine being a child who is battling with a mental health issue such as living with anxiety. Imagine worry so deep that it consumes every moment and sleep is no release. Imagine being permanently vulnerable. Imagine worry so encompassing that it changes your physical state, with pain and nausea taking over. It is debilitating. Imagine having that day in, day out.

What are the chances of getting support? Young people are meant to be seen within 18 weeks of referral. Imagine being one of 28,000 people referred to CAMHS, a third of whom will not be seen. That is 8,988 children in Scotland right now who are not being seen within 18 weeks of referral. Now imagine being one of the 6,553 children who are refused CAMHS treatment and who find out that, having waited more than four months—it is more than a year in some cases—they have been rejected from the service, although their GP referred them, which in itself took months, and that, although they are years on, they are no further forward.

As Alex Cole-Hamilton stated, this Government has its own NHS recovery plan and set targets to clear CAMHS and psychological therapies waiting lists by March this year. That is in 10 weeks’ time, and, with 8,331 children and young people on the list waiting to start treatment at the end of September, I think that it is safe to say that that target will not be met.

The fact is that, when it comes to health, targets set by this Government are rarely met. The target of 90 per cent of children and young people starting treatment with CAHMS within 18 weeks of referral is not being met. The target of 95 per cent of A and E patients being seen within four hours is not being met. The target of 95 per cent of patients beginning cancer treatment within 62 days of referral is not being met. That worries me, because no-one is setting these targets for the Scottish Government—it is setting them for itself, and it seems that they are setting up the NHS to fail. The British Medical Association has highlighted that very point by stating that,

“for too long the debate on the health service has focussed on quick fixes, or short-term performance against waiting times targets that are widely accepted as completely unrealistic”.

Let us look at staffing issues. The fact is that NHS managers have been predicting a massive shortfall in staff. It has been on the cards for years. They all knew that this day would come. If we want an example, we do not need to look any further than when the First Minister was health secretary, which was at a far easier time—that is self-confessed—than we are in now. She was slated for sowing the seeds of a hiring crisis in the Scottish nursing sector through the controversial decision to slash the number of student nurses between 2007 and 2012, which has led to a decade-long staffing shortage. At the time, the Royal College of Nursing strongly criticised the move by the Scottish Government to slash the number of training places for nurses and midwives by nearly 300 back in 2012-13. Announcing the cut to student nursing places in 2012, Ms Sturgeon said that the reduction was a “sensible way forward” to minimise the risk of oversupply—so that aged well.

Again, the BMA highlights that and asks us to take

“serious steps to make working as a doctor an appealing career choice”.

That is needed because

“there is less GPs capacity available to care for the people of Scotland than at any point since 2009”.

On a point of order, Presiding Officer. I am finding it difficult to hear my colleague because of the conversations that are going on in the chamber.

Thank you, Ms White. I ask all members to please note what Ms White said. We must obviously listen to the speaker who has the floor. Ms McCall, please resume your speech.

We have to cut through the political fog, because, when all is said and done, the people of Scotland are not getting the healthcare that they should be getting. People need the NHS to be there when they need it. Our job is to focus on fixing the problems, not to blame others or highlight how much better off people in Scotland are.

Believe me, people just need to feel that they are being taken care of. In a scary, stressful time, when they are ill and do not know what is going to happen next, and when our amazing NHS staff come forward time and again to help and treat the sick and the dying, they want our politicians to step up, be realistic and just make it better. So, can we agree to get Scotland’s NHS off life support and ready for the people who need it to be there when they need it?

16:35  

The crisis in our health and social care services has engulfed every part of our NHS in every part of the country, but, in rural areas, where services are especially precarious, the impact has been profound. A day rarely goes by when my inbox does not contain another heartbreaking case that exposes how utterly broken services are.

Today, a third of beds in Dumfries and Galloway royal infirmary are occupied by patients whose discharge is delayed by the lack of carers and care home places. More than 3,000 hours of assessed care are not being covered. I will share just one such case.

I was contacted by a constituent whose mum, Pat, was receiving palliative care after a cancer diagnosis. Pat’s wish was to spend what time she had left at home. Her care needs were, of course, increasing, but that wish was not too much to ask. An assessment was made and a care package agreed, but there were no carers to deliver it. Marie Curie did what it could, as did the family, but the growing burden on Pat’s husband became too much and he was admitted to hospital, utterly broken. What was the solution? There were still no carers, so Pat was also admitted to hospital, even although she was not receiving any medical treatment. Pat sadly died several days later. The only saving grace was that, because she was in hospital and her husband had also been admitted, he was by her side in her final moments.

That is not an isolated case. The lack of carers and the problem of delayed discharge have not suddenly appeared because of Covid or the flu. They were there in 2015 when the SNP promised to eradicate delayed discharge. However, eight years on, we have never been so far away from achieving that.

The cabinet secretary consistently says that we cannot afford to pay our care workers the bit more that could help to recruit the carers who are needed to avoid more cases like Pat’s. Delayed discharge last year cost NHS Dumfries and Galloway alone more than £6 million. We cannot afford not to give our care workers a decent pay rise. Until we do, there is no route to ending delayed discharge and no way to avoid more cases like Pat’s.

Two years ago, community hospitals in Kirkcudbright, Newton Stewart, Langholm and Moffat were closed, which removed nearly 60 beds. Post Covid, they remain closed because nurses from those hospitals are in the community and, in many cases, having to carry out the role of care workers because we cannot recruit those workers.

The health secretary’s sticking plaster is to pay health boards to discharge patients not back home where they want to be but into care homes where they do not want to be—and, in rural areas, those care homes are often miles from their family. That will not work: although many boards are already buying up beds in care homes, there are not enough because those homes also cannot recruit care staff.

In the past year alone, two care homes in Dumfries and Galloway have closed and, just this week, they were joined by another in East Ayrshire. We now have diktats from health and social care partnerships such as the one in Dumfries and Galloway—diktats that, this week, sanctioned the discharge of patients from hospital even if they have not had suitable re-enablement, and the discharge of patients not when their care package starts but when a date has been given for that care to begin at some point in the future, with all the risks that that brings.

Social care recruitment is not the only area in which Government inaction has led to a crisis. In 2018, the maternity unit at the Galloway community hospital in Stranraer was shut. We were told that it was shut temporarily because of a shortage of midwives.

One of my constituents, Claire Fleming, lives in Glenluce, which is 15 miles from Stranraer. Her first pregnancy was with Abbey, who was sadly stillborn. Despite the heartbreaking end to that pregnancy, she had to drive herself to the hospital in Dumfries to deliver Abbey—that is 60 miles away. Since then, she has had three children—Molly, Andrew and James—and, along with her husband, Richard, has clocked up more than 7,500 miles between her home and the hospital in Dumfries for maternity appointments because, even before the maternity unit in Stranraer was closed, services had been scaled back.

Claire suffered from hyperemesis during pregnancy, which meant that she had to stop every 15 minutes on the journeys to Dumfries in order to be sick. Claire told me that she is aware of women in Wigtownshire who decided not to get pregnant because they were so scared of having to make that journey in a rush if they went into labour, for fear that they would have to give birth in a lay-by at the side of the road.

Claire said:

“I would have as many children as I could. I absolutely loved having children. But I got sterilised the last time I was in the hospital ... because I couldn’t face doing that journey again with hyper-emesis.”

There is still no sign of the Stranraer maternity unit—

Will Colin Smyth take an intervention?

I will—provided that I can have the time back. Can I, Presiding Officer?

Not really, I am afraid. You would have to accommodate it within your time.

I am sure that Emma Harper will cover her point in her own speech.

That maternity unit, which is the eighth-largest of Scotland’s 22 community midwifery units, has still not reopened for in-hospital births, and there has been a 60 per cent increase in the already high level of nursing and midwifery vacancies in the region since it closed.

I could talk about so many other services in the region that are on their knees. On dentistry, for example, in the past few months alone, dental practices in Dumfries, Castle Douglas and Gretna have closed, which has affected 15,000 patients. At the moment, it is not possible to register with an NHS dentist in Dumfries and Galloway.

On GP surgeries, residents in Lockerbie, Moffat and Stranraer have had their surgeries brought under direct control by the NHS because there are simply not enough GPs.

The legacy of 15 years of SNP government for the NHS in Dumfries and Galloway is that delayed discharge has risen by 56 per cent in a year; people cannot get an NHS dentist; GP surgeries are closing; and women fear for their health when pregnant. Our NHS and social care services desperately need a proper long-term plan. As we have heard today, it is clear that the cabinet secretary and the Government are utterly incapable of delivering such a plan.

I call Emma Harper, who will be the final speaker in the open debate.

16:42  

As a former NHS employee in education and in the perioperative environment, I regularly hear from fantastic colleagues about what is happening on the ground. I am acutely aware of the challenges that our health and social care system faces, and I know the lengths to which staff are going to meet the unprecedented demands that they face.

I want to address the issues that Colin Smyth raised in relation to maternity services in Stranraer and dentistry. I know that he would have taken an intervention if there had been time. I raised the issue of maternity services directly with the cabinet secretary at Tuesday’s meeting of the Health, Social Care and Sport Committee. The cabinet secretary is aware that Maree Todd, the Minister for Public Health, Women’s Health and Sport, is addressing maternity issues and supporting the work of the action group, which includes Colin Smyth. The cabinet secretary has given a commitment to get back to me on some of the issues that I raised in committee on Tuesday. I am sure that, when I get those responses, we will be able to work together to support what works best for our constituents in the south of Scotland.

Edward Mountain made a comment about the national treatment centre only doing the easy cases. In my experience of orthopaedic surgery, it is sometimes easier to do five total joints in one day, as those are planned, predictable and manageable cases, than it is to do one very long and difficult loss-of-blood surgery that would take up the whole orthopaedic session. I make that point off the top of my head, but I might pursue the issue further down the line.

This is the most challenging winter that the Scottish NHS has ever faced. Immediate pressure will continue in the coming weeks. Christine Grahame talked about the fact that Covid is still stalking the corridors. I make a plea to people to get their Covid vaccine, if it is due and they are avoiding it, and to get their flu vaccine as well, because, ultimately, that will help to keep folk oot o the acute care beds. I think that many members across the chamber would agree with me on that.

The Labour Party might not like to hear this, but our NHS in Scotland is consistently performing better than the NHS in any other part of the UK, and our staff are paid a bit more.

The Labour motion talks about properly funding our Scottish health and care service. The Scottish Government is ensuring that all actions are being taken to support services, and additional measures outlined just this month are already having an impact in Dumfries and Galloway. The measures will help the NHS and the social care sector with on-going extreme winter pressure. Health and social care partnerships have received a share of £8 million to procure around 300 additional care home beds to help alleviate pressure—

Will the member take an intervention?

Just let me finish this one wee point, then I will.

The pressure that we are trying to alleviate with 300 additional care home beds is caused by delayed discharge. That funding will allow health and social care partnerships to pay more than the national care home rate for beds, which is £719.50. That is in addition to the 600 interim care beds already in operation in the country.

I will give way to Jackie Baillie before I come on to what is working in Dumfries and Galloway.

Does Emma Harper recognise that when Nicola Sturgeon was health secretary, she failed to pass on to the NHS funding for it that would have meant that we would be £1 billion better off today?

What is being passed on to the NHS in Scotland is more than the consequentials that are being given to us. It is oor taxpayers’ money that is being divvied up by folk that we didnae even vote for. It is probably good that Jackie Baillie made that intervention.

In Dumfries and Galloway, thanks in no small part to the work of the health and social care partnership’s chief operating officer, Julie White, that support has enabled the board to discharge from hospital 25 people who were medically fit for discharge but whose discharge had been delayed. That was achieved in one week, and I congratulate Julie White and the teams on that success. I understand that the approach taken by Dumfries and Galloway health and social care partnership is being shared with other boards. I look forward to the update from Julie and the teams at NHS Dumfries and Galloway and the health and social care partnership and to hearing how that was achieved. If some boards can make it work, let us share the good practice and get it done.

In addition, NHS 24 is taking forward plans to recruit around 200 new starts before the end of March. In the run-up to Christmas, more than 40 whole-time equivalent call operators, call handlers and clinical supervisors were recruited, allowing for more people to be directed to the most appropriate care setting for them.

On funding more generally, the Scottish Government has committed in the budget more than £18 billion for health and social care. That is around 52 per cent of the overall budget for the Scottish Government. Again, we dinnae have control over what comes our way. I want to pick up on Emma Roddick’s points about employment law. It is really hard to manage what we would like to do when we constantly have a ball and chain roon the neck of this place.

I would like Labour to be a bit more realistic.

Will the member take an intervention?

The member is concluding.

The £600 million health and care winter plan is supporting the recruitment of 1,000 additional multidisciplinary staff and delivering £45 million for the Ambulance Service to support on-going recruitment and services.

I realise that I am out of time, Presiding Officer. I welcome the steps that the Scottish Government continues to take to help to support our fantastically valuable national health service in Scotland.

We move to closing speeches.

16:48  

As I have listened to this afternoon’s debate, it has been painfully clear that this SNP-Green Government has run out of ideas and has run out of road. The cabinet secretary says that the NHS is facing challenges. The fact is that under Humza Yousaf, Scotland’s NHS is not just on life support—

Will the member take an intervention?

Presiding Officer, I have only just begun. I might look keen, but I would like to continue.

As we have heard today, we are seeing patients stuck in ambulances on the hospital forecourt, week after week of record waiting times in A and E, moving medical goal posts, a delayed-discharge crisis, non-elective surgery paused and massive backlogs in potentially life-saving treatments, diagnostic tests and operations. There are so many people in pain.

Dr Sandesh Gulhane said that the SNP Government will blame Covid: true to form, Emma Roddick and Humza Yousaf blamed Covid.

The majority of speakers in today’s debate have exposed the fact that the underlying problems are long in the making. I ask Emma Roddick, who talked about fingers in ears, to listen to what has been said today. Paul Sweeney shared harrowing stories and Sarah Boyack talked about preventative care being stopped. We have heard so many stories of people who are frustrated, upset, forgotten or abandoned.

NHS front-line workers are telling us time and again that patient safety is at risk every day. Dedicated staff in our NHS are exhausted, disheartened and in disbelief. Not surprisingly, as Michael Marra has flagged, clinicians are thinking of chucking it in.

Alex Cole-Hamilton exposed the shocking story of a refugee who had to go back to war-torn Kiev for her medical treatment. However, John Mason had the temerity to accuse Jackie Baillie of exaggerating the crisis. He should pause on that and try telling it to the patient in Inverness who has been waiting 12 weeks for a GP telephone appointment, to the patient who has been waiting four years for a hip replacement, or to someone who has been waiting for life-changing cancer treatment. I ask Gillian Martin who it is that is “hiding behind the couch.”

Imagine how those patients felt on Monday, when the First Minister used a press conference on the crisis in our NHS to grandstand on the constitutional wrangling over the Gender Recognition Reform (Scotland) Bill on the same day that it emerged that one patient in my region, under NHS Grampian, had waited five years for a simple computed tomography—CT—scan.

As we have witnessed today, all the SNP does is sing from the same songbook. It deflects, distracts and—as we have heard again and again today—it blames the UK Government or, as David Torrance did, blames Labour for what it did more than 15 years ago. Really? Emma Roddick, who obviously does not understand employment legislation, has blamed the UK Government for the ball and chain on that legislation. Poppycock!

However, the question remains: how can the NHS come back from the brink after 15 years of mismanagement under the SNP Government? We have sensible policy proposals. The cabinet secretary asked earlier where our ideas are. He has run out of ideas; he is asking us for them. We have published ideas on crisis maximum waiting times, an electronic repeat prescription system, an app for live hospital waiting times; and “prehab”—[Interruption.]

The cabinet secretary, from a sedentary position, said, “Do it tomorrow”—I say to him that we have been waiting 15 years.

Our published proposals could make a real and defining difference, not just to how the NHS works and the pressures that it faces, but to patients’ experience of the system. If the cabinet secretary would like some ideas because he has run out of them, we will gladly meet him to share ours.

On the wider health system, we know that delayed discharge is a massive issue that prevents the flow of patients through the NHS from A and E on to other wards. More often than not, bed blocking is caused by a lack of social care packages at home or in the community, thanks in part to savage funding cuts to local authorities by the SNP Government.

However, instead of going full throttle to address the problem now, the SNP, in its wisdom, has decided to introduce legislation to set up a centralising national care service three years down the road with soaring cost implications for the public purse. The reality is that the 300 additional care home beds that the health secretary announced will not cut it when more than 1,700 people in hospital are clinically safe to leave but cannot do so.

On staffing, we know that the NHS workforce is massively understaffed with high vacancy rates. In fact, figures from the BMA suggest that consultant vacancies are more than double the Scottish Government’s official figures. There is still no proper workforce plan. The NHS will continue to haemorrhage staff if working conditions do not improve. That is not the exception; it is the norm, so we must urgently find ways to address the situation.

16:54  

We are all aware of the pressures that our NHS and social care settings face during this very challenging winter. I do not seek to lessen the extent of those challenges nor the very real impacts that they have on people across Scotland, whether they are the hard-working front-line clinicians who work day and night to deal with unprecedented demand or the people who are waiting for treatment or facing delays when visiting hospital.

This is a moment of significant challenge, and we are determined to support all of healthcare and social care through it.

Presiding Officer, as the cabinet secretary remarked, there is no mention in Ms Baillie’s motion of the impacts of Covid-19, Strep A or flu, all of which are placing significant pressures on hospitals and wider services. This is not the first time that that has been pointed out to Scottish Labour when we are responding to such motions.

In his response, the cabinet secretary set out the detail on the numbers of people affected by Covid-19 alone who are now receiving care in hospitals and clinical settings across Scotland. To ignore that critical clinical picture is to ignore one of the key underlying causes of the pressures that health and social care settings face. It also misunderstands the solutions that are needed to help to reduce pressures on hospitals, and the steps that we can all collectively take to mitigate the pressures.

There is also no mention in the motion of the impact of Brexit or the UK Government’s mishandling of the cost of living crisis. Brexit continues to have an effect on health and social care staffing. The Nuffield Trust recently highlighted the impact of Brexit on the health workforce, and outlined the decrease of 28 per cent in the numbers of EU and European Free Trade Association nurses and health visitors on the UK register between September 2016 and September 2021. That is a potential decrease of more than 10,000 people working in health settings across the UK. Although not all of them would be working in Scotland, it is undeniable that Brexit, which Scotland did not vote for, has had a significant impact on recruitment of health and social care staff.

Finally, we know that the impact of the UK Government’s mishandling of the economy has made things worse, and has put more pressure on households, thereby exacerbating mental and physical health challenges. We have seen folk turning up at our hospitals suffering from extreme cold because they are afraid to put their heating on. That is the type of thing that people face because of the cost of living crisis, and which our health and social care services have to deal with.

We have done what we can to mitigate the challenges. We have introduced the Scottish child payment in addition to wide-ranging support measures to assist families who urgently need support through the cost of living crisis.

The Scottish Government values immensely the contribution of people from across Europe and the world who work in the NHS and have chosen to make Scotland their home. That is why, in our amendment to the motion, we mention our belief that freedom of movement within Europe would help us to address some of our recruitment challenges.

We have taken sensible and ethical approaches to staffing, including investing in training places, creating new roles and routes into NHS Scotland and publishing “National Workforce Strategy for Health and Social Care in Scotland”. We have also announced measures to deal with hospital discharges and the surge in cases that we are experiencing as a result of winter pressures, including Covid-19, flu, Strep A, and other infections.

I mentioned in my speech the £430 ambulance cost to transfer a 95-year-old constituent from one health board area’s hospital to a care home in another health board area. Does the minister recognise that we should not tolerate such incidents in the NHS?

I was going to come to that point. I would be interested to get further detail about that case from Mr Sweeney, because a transfer between one health board and another should not be charged for by the Scottish Ambulance Service. There is no doubt that we will investigate that.

As I was saying, we announced those measures to ease the pressures, including Covid-19, Strep A, flu and other infections. The cabinet secretary outlined the actions that we are taking, which include not only increased capacity for interim care beds and the scale up in NHS 24 that were announced last week, but the investment—through the NHS recovery plan—to support national treatment centres; additional investment to increase adult social care workers and put in place the national care service, which will deliver the long-term reform that is needed to provide fair work; and national sectoral bargaining for social care workers.

We also highlighted that Scotland is the only part of the UK not to experience strike action from health staff this winter. That is because the cabinet secretary has continued to talk with and listen to staff, and to negotiate properly—unlike what is happening south of the border. He is right to highlight our profound respect for the workforce and the Government’s commitment to positive and meaningful engagement with trade unions. We will continue to negotiate in good faith to achieve an outcome that avoids industrial action and rewards our workforce with the support that it deserves.

I recognise the strength of feeling on all sides of the debate, but in some cases there has been more heat than light. The cabinet secretary and I have been consistently clear that this will be one of the most challenging winters that the NHS in Scotland has ever faced, but the picture that is presented by the motion ignores critical context, such as the impact of Covid-19, flu, Strep A and other infectious diseases on the health service. It also ignores the impacts of Brexit and of the cost of living crisis—which are exacerbating those pressures—and it ignores the steps that the Government has taken to support patients and professionals and to put in place the long-term reform that is required in health and social care.

I urge members to back the amendment in the name of the cabinet secretary.

17:02  

As we meet to debate this issue in this place, outside our NHS continues to face a huge crisis. Yet again, it is Scottish Labour, during Opposition business time, that has had to bring the issues that Jackie Baillie outlined in her opening speech to the chamber to ensure that the Government can be held to account.

Our thoughts are with all our dedicated and hard-working staff who are on the front line of our NHS. Never before have our accident and emergency departments had so many patients waiting more than 12 hours to be assessed. Never before have we experienced such a level of delayed discharge, with record numbers of patients stuck in hospital because they cannot secure an appropriate care package.

Tragically, as we have seen many times before, there is also declining performance in cancer treatment. The Scottish Government has failed to meet its own 62-day cancer treatment standard since 2012. All the statistics that we see week in, week out are not just box-ticking exercises; they are more fundamental than that. This is about people’s lives and about improving outcomes by ensuring that people have a higher likelihood of being treated before their condition worsens. In many cases, treatment can be the difference between surviving and recovering, and dying.

Indeed, waits of more than eight hours in accident and emergency departments have already led to avoidable deaths in our hospitals.

“Patients who need to be in intensive care or high dependency units are sitting in A and E departments for hours waiting, it is just not safe ... Patient safety is at risk every day in our A and Es across Scotland. You just can’t give the care you want to give to patients.”

Those are not my words; they are the words of Dr Lailah Peel, the deputy chair of the BMA in Scotland, another of those front-line voices that we have heard throughout the debate and which, sadly, have been characterised as exaggerated by members on the SNP benches.

However, that is the reality. It is the reality that I have heard; it is the reality that we have heard from colleagues across the chamber. In response, the cabinet secretary has sought—as he always does—to absolve himself of responsibility by lining up excuse after excuse. I have to say to the cabinet secretary that I found his weaponising of Covid in his remarks most unedifying, because the reality is that clinicians and those on the front line are saying that the cause of the current crisis is not about Covid; it is not about Strep A, the flu or winter pressures. It is about years of mismanagement and decline.

Who said that?

Dr Peel, who I just mentioned, said—

It has nothing to do with Covid?

I am going to quote her:

“The word unprecedented is being used a lot to describe the ... crisis ... It makes it sound like the current situation wasn’t entirely predictable or preventable ... Like this isn’t a crisis years in the making.”

Front-line workers are sick and tired of not being listened to by the Government and they are appalled by moves, as they see it, to blame patients for the appalling situation in our NHS.

Presiding Officer, our national health service is battling for survival in this, the gravest of moments that it has faced since its establishment by the Labour Party. The gravity of the situation demands a response from the Scottish Government of a proportionate magnitude. It needs more than the reactive sticking-plaster proposals from the First Minister and the health secretary.

In December, the Nuffield Trust said:

“The health and care sector is still reeling from the effects of a global pandemic and is now grappling with rising cost pressures.”

Is it weaponising Covid?

If the member had listened to what I said, he would have heard me quote a front-line clinician, who pointed out that Covid, Strep A and flu—all the issues that we have heard about—are exacerbating an issue that has been 15 years in the making. This crisis has been building year on year and this Government has not sought to address it appropriately, because its recovery plan does not even come close to addressing the scale of the problem that is facing our health service.

This is a twin crisis—it is a twin failure of Government in both healthcare and social care. That is why we need a joined-up approach to deal with the problem, because we will not be able to deal with the issues that are facing our health service if we do not address social care.

This morning, along with Jackie Baillie and Anas Sarwar, I met a range of stakeholders, including people on the front line of delivering social care. Their testimony on the scale of the challenge being faced in social care was powerful and they were clear in stating that the Scottish Government is not doing enough to address the key problems in social care.

If we look at the budget for 2023-24, where every single penny is allocated, can the member tell me where he would find the money, or where he would cut money, in order to fund social care wages to £15 an hour, or even £12 an hour? [Interruption.] He should not say from the national care service, because it would not even remotely, in 2023-24, cover any wage rise. [Interruption.]

I am not going to take a lecture from the cabinet secretary about what I should—[Interruption.] The cabinet secretary is obviously quite upset by my response. [Interruption.] There needs to be a conversation about his national care service plans because they are where we could take money from in order to put it into the front line on social care—[Interruption.] We will make our budget proposals, as we always do, and we will provide that information to the cabinet secretary.

I go back now to my point—[Interruption.]

The cabinet secretary does not want to listen.

Mr O’Kane, can you resume your seat?

I spoke about this at the beginning of the debate—I do not know what has happened in the interim, but it appears to be reigniting at the end of the debate. Again, members on the front benches and some back benchers are hurling comments at each other while a member is on his feet trying to speak. I would encourage people to treat those who are speaking with respect and I invite Paul O’Kane to start to conclude his remarks.

I am very grateful, Presiding Officer.

Perhaps the cabinet secretary does not want to listen to what I heard from social care workers today, which is that they have grave concerns about the situation in social care, that the National Care Service (Scotland) Bill is ill thought out and should be stopped, and that we should come back around the table to get it right.

I heard Gillian Martin quote Unison saying that it is in support of the bill—that is certainly not the conversation that I had with the union this morning.

Will the member give way?

I do not believe that I have time to take an intervention from the minister.

Unison is calling for the process of the creation of a national care service to be paused and for us to think again about the detail.

I will conclude, Presiding Officer. I plead with the health secretary to show some humility and to listen to the experience of staff who are on the front line and of patients who have witnessed the crumbling foundations of our NHS with their own eyes. Our doctors, nurses and support and social care staff deserve so much better than hollow words. Patients across Scotland deserve better than the underwhelming action of the SNP Government. We on these benches will always fight to protect our NHS. Will the cabinet secretary?

That concludes the debate on addressing the crisis in the NHS and social care. It is time to move on to the next item of business. There will be a brief pause to allow members on the front benches to change position.